Objective To evaluate the clinical application of open reduction and internal fixation and bone grafting on treatment of pilon fractures of tibia.Methods Forty cases with Pilon fractures of Ⅱ,Ⅲ tibia who underwent open reduction and intemalfixation and bone grafting treatment were selected as our subjects.Those 40 cases were performed follow-up for 8.0-60.0 months,and average was 31.5 months.The ankle joint symptoms and functional Mazur scoring system were used to evaluate the function of ankle joint.Results Of the 40 patients,15 cases were with excellent ankle function,and 19 cases were good,4 cases were poor and 2 cases were worse.The excellent and good rate was 85％ (34/40).Conclusion Open reduction and internal fixation and bone grafting is proved as the effective treatment on Ⅱ,Ⅲ tibia pilon fractures.

Objective To investigate surgical outcomes of treatment of pilon fractures of Ruedi -Allgower types Ⅱ and Ⅲ by raft screws fixation combined with bone grafting.Methods 21 patients with pilon fractures of Ruedi -Allgower types II and Ⅲ received surgery were selected.They were 15 men and 6 women,23 to 68 years of age(average 38.2 years).16 cases were closed and 5 cases open.12 cases were type II and 9 cases type III.Intervals between injury and operation ranged from 7 to 14 days,with 8.5 days on average.All of them were treated with raft screws fixation by plate type L combined with bone grafting.Results All cases were followed up for an average of 12 months(range from 8 to 30 months).Fractures healed from 16 to 24 weeks,with 18.2 weeks on average.According to the Burwell -Charnley radiological criteria,anatomical reduction was achieved in 17 cases,and fair reduction in 4.According to the Mazur clinical criteria,ankle functions were rated as excellent in 8 cases,good in 10 cases,fair in 2 cases and poor in 1 case.The rate of excellent and good was 85.7%.Conclusion Raft screws fixation combined with bone grafting are effective for the pilon fractures of Ruedi -Allgower types II and Ⅲ,preventing articular surface collapse and leading to anatomic reduction,and has stable fixation and early functional rehabilitation.

Objective: To obtain the dietary exposure of lead in primary, middle and high school students, and to provide basic foundation for food safety risk assessment and management for children and adolecsents. Methods: Weighing method, 3-days hour dietary survey, combining with the food frequency questionnaire, was applied to obtain basic dietary data in 616 primary, middle and high school students selected through multi-stage randdom sampling method from Pudong new area of shanghai. Data on lead concentrations were derived from the food safety risk monitoring system, which included 1 145 samples. Results: Lead was detected in 568 of 1 145 samples (49.61%) from 10 categories of foods. The exceeding standard rate was 3.58% (41 samples exceeded). The average content of lead was (0.12±0.25) mg/kg, fungi and algae, beans and the aquatic products were found to be the primary food sources of lead exposure. The average dietary lead exposure in primary, middle and high school students was 9.94 μg/kg per week, accounted for 39.76% of PTWI. The lead exposure level at the 97.5th percentile which accounted for 118.24% of PTWI was 29.56 μg/kg. Vegetables, beans and cereal foods were the mainly source of dietary lead exposure, with average dietary lead exposure 2.57, 2.44 and 1.43 μg/kg peer week, accounted for 10.26%, 9.76% and 5.74% of PTWI, respectively. Conclusion Lead is present in some foods available in local markets in Pudong New Area, Shanghai. Low level of dietary exposure to lead is found in primary, middle and high school students, however, it depends on dietary pattern. Continued efforts are needed to reduce the dietary exposure of lead in school students.

Background Papillary thyroid cancer is the result of a variety of pathogenic factors. The prevalence of papillary thyroid cancer varies greatly in different regions, and the disease is more harmful to women. Objective This study aims to explore the relationship between reproductive factors and papillary thyroid cancer, and to provide basic data for prevention and control of the disease. Methods A 1∶1 age (±3 years) matched case-control study was conducted in 331 pairs of newly confirmed papillary thyroid cancer cases and controls from two hospitals in Shanghai from November 2012 to December 2013. Comparisons were made in the history of menstruation, pregnancy, gynecological and breast diseases, and other variables between the two groups. Results The results of univariate analysis indicated that the proportions of education below bachelor degree, married, and mainly manual workers in the case group were significantly higher than those in the control group (P<0.05); the proportion of those with a family history of thyroid diseases in the case group was significantly higher than that in the control group (P<0.05); the proportions of the cases with irregular menstruation (77.34%), a history of using oral contraceptive or hormone drugs (24.77%), a history of benign gynecological diseases (31.72%), and a history of gynecological surgery (9.67%) were significantly higher than the proportions in the control group (P<0.05). After adjusting potential confounding factors such as history of CT examination, age, kinds of family salt, total iodine intake every day, education level, occupation, marital status, body mass index, and family history of thyroid diseases, the results of multiple logistic regression analysis showed that irregular menstruation (OR=1.767, 95%CI: 1.122-2.782; P=0.014), surgical menopause (OR=12.787, 95%CI: 3.202-51.057; P<0.001), pregnancy >1 time (OR =2.490, 95%CI: 1.196-5.184; P=0.015), and the history of using oral contraceptive or hormone drugs (OR=2.389, 95%CI: 1.338-4.268; P=0.003) were the risk factors of papillary thyroid cancer. Conclusion Irregular menstruation, surgical menopause, history of pregnancy, and history of using oral contraceptive or hormone drugs might be the risk factors of papillary thyroid cancer. To reduce the incidence of papillary thyroid cancer, strengthened health education and rational use of contraceptives are recommended.

【Objective】 To understand the prevalence of overweight/obesity among school-age children in Pudong New Area of Shanghai, and to explore the influence of gestational weight gain and pre-pregnancy body mass index (BMI) on weight status of school-age children. 【Methods】 From November to December 2020,a stratified cluster sampling method was adopted to select first-grade students from 13 primary schools in Pudong New Area of Shanghai.After matching with the birth monitoring database, 755 students with complete birth information were selected as the study subjects.The relevant information of mothers before and during pregnancy was retrospectively collected, and the effects of pregnancy weight gain combined with pre-pregnancy BMI on overweight/obesity in school-age children were analyzed. 【Results】 1) The prevalence rates of overweight and obesity of first-grade children were 15.89% and 18.41%, respectively.2) Maternal excessive weight gain during pregnancy (OR=1.678) and overweight/obesity before pregnancy (OR=2.315,2.412) were risk factors for overweight/obesity of the offspring at school age(P<0.05).3) For mothers who were underweight before pregnancy, excessive weight gain during pregnancy was associated with overweight/obesity in school-age children in their offspring (OR=7.436, 95%CI: 1.489 - 37.143,P<0.05).4) Excessive weight gain during pregnancy combined with overweight/obesity before pregnancy significantly increased the risk of overweight/obesity in offspring (OR=3.606, 95%CI: 2.030 - 6.405, P<0.05). Mothers who gained a moderate amount of weight during pregnancy and were emaciated before pregnancy had a significantly lower risk of overweight/obesity in their school-age children (OR=0.217, 95%CI: 0.049 - 0.967, P<0.05). 【Conclusion】 Excessive weight gain during pregnancy increases the risk of overweight/obesity in school-age children in their offspring, strengthening pregnancy health education and perinatal care to help pregnant women maintain appropriate weight gain during pregnancy may be an important and novel strategy to prevent childhood obesity.